Provider Demographics
NPI:1326069915
Name:JOHN B PHILLIPS MD
Entity Type:Organization
Organization Name:JOHN B PHILLIPS MD
Other - Org Name:MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-847-6373
Mailing Address - Street 1:50 SKYLINE LN
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-2345
Mailing Address - Country:US
Mailing Address - Phone:731-847-6373
Mailing Address - Fax:731-847-6579
Practice Address - Street 1:50 SKYLINE LN
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2345
Practice Address - Country:US
Practice Address - Phone:731-847-6373
Practice Address - Fax:731-847-6579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710410Medicaid
TN3710410Medicaid